U.S. - Mexico Border U.S. - Mexico Border 2004 IMMUNIZATION WEEK PREPARATORY WORKSHOP QUITO, ECUADOR, JANUARY 29-30, 2004 Eva M. Moya, LMSW U.S.-Mexico Border Health Commission, U.S. Section Catherine Torres, MD Commission Member Dra. Eva Margarita Solorzanó U.S.-Mexico Border Health Commission, Mexico Section Lic. Piedad Huerta Pan American Health Organization

If the border were a separate state, it would rank... Last in access to health care Last in access to health care Second in death rates due to hepatitis Second in death rates due to hepatitis Third in deaths related to diabetes Third in deaths related to diabetes First in the number of cases of TB First in the number of cases of TB First in school children living in poverty First in school children living in poverty Last in per capita income Last in per capita income

Region 13 million inhabitants -- Mexico: 6.4 million Mexico: 6.4 million U.S.: 6.6 million U.S.: 6.6 million 2,000 miles in length U.S. counties 44 U.S. counties 80 Mexican municipios 80 Mexican municipios

 63.7% of the population lives on the U.S. side  36.3% of the population lives on the Mexican side  47% of the border population is under 20 years of age Population Highlights Source: Healthy Border 2010

Population by Age Groups and Sex

Poverty Conditions 38% fall below 200% of poverty 38% fall below 200% of poverty Unemployment rate is times higher than U.S. average Unemployment rate is times higher than U.S. average 3 of the 5 poorest cities and 4 of the 10 poorest U.S. counties are in this area 3 of the 5 poorest cities and 4 of the 10 poorest U.S. counties are in this area 37 of 45 counties in immediate border area are Health Professional Shortage Areas 37 of 45 counties in immediate border area are Health Professional Shortage Areas

United States Heart Disease Heart Disease Malignant Tumors Malignant Tumors Cerebrovascular Diseases Cerebrovascular Diseases Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Accidents Accidents Pneumonia and Influenza Pneumonia and Influenza Alzheimer's Disease Alzheimer's Disease Chronic Liver Disease and Cirrhosis Chronic Liver Disease and Cirrhosis Suicide Suicide Primary Mortality Causes in the Border Source: Healthy Border 2010

Mexico Border Heart Disease Heart Disease Malignant Tumors Malignant Tumors Diabetes Mellitus Diabetes Mellitus Accidents Accidents Cerebrovascular Diseases Cerebrovascular Diseases Chronic Liver Disease and Cirrhosis Chronic Liver Disease and Cirrhosis Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Pneumonia and Influenza Pneumonia and Influenza Diseases Originated in the Prenatal Period Diseases Originated in the Prenatal Period Homicide Homicide Source: Healthy Border 2010

Our people…

Language and cultural barriers Language and cultural barriers Cost of care Cost of care High Unemployment (U.S.) and lower wages High Unemployment (U.S.) and lower wages Inadequate distribution of health care resource and lack of training Inadequate distribution of health care resource and lack of training Denial of access to services for undocumented (illegal status) individuals Denial of access to services for undocumented (illegal status) individuals Barriers that Affect Access to Health Care Source: Border Vision Fronteriza 1996

Different cultures and languages Different health systems Severe macro-economic issues Isolation from D.C. and Mexico D.F. Higher chronic disease rates Higher population growth and unemployment rates Challenges in Conducting Border and Bilateral Work

Establishment of the Commission U.S. Public Law authorized the president to enter into an agreement with Mexico to establish the Commission. In 2000 – the binational agreement which creates the Commission was signed.

“To provide international leadership to optimize health and quality of life along the United States-Mexico border” “To provide international leadership to optimize health and quality of life along the United States-Mexico border” Mission

Roles Promote social and community participation; Promote social and community participation; Act as a catalyst for needed change; Act as a catalyst for needed change; Act as a policy advocate; Act as a policy advocate; Increase resources for the border; and Increase resources for the border; and Encourage self-responsibility for health. Encourage self-responsibility for health.

Two sovereign nations Two sovereign nations Ten border states Ten border states 44 counties and 80 municipalities 44 counties and 80 municipalities 14 pairs of sister cities 14 pairs of sister cities 26 Commission members 26 Commission members Interagency team and core partners Interagency team and core partners U.S. and Mexico funds and appropriations U.S. and Mexico funds and appropriations Structure

Recommendations to Governments

The border-wide and bi-national program of health promotion and disease prevention. The border-wide and bi-national program of health promotion and disease prevention. Establishes 20 priority health objectives for the border. Establishes 20 priority health objectives for the border. Healthy Border 2010 is:

Healthy Border/Healthy Gente Objectives Focus attention on key health issues Focus attention on key health issues Improve allocation of health resources Improve allocation of health resources Coordinate public and private action Coordinate public and private action Inspire ownership of objectives Inspire ownership of objectives Achieve objectives through: Achieve objectives through:  coordinated program activities  community projects

Healthy Border 2010 Program offers an agenda that approaches in a binational manner the health priorities that have been defined for the border region by the two governments and the ten states. Program offers an agenda that approaches in a binational manner the health priorities that have been defined for the border region by the two governments and the ten states. Presents specific objectives to improve health in the border communities to year Presents specific objectives to improve health in the border communities to year 2010.

Healthy Border Agenda Access to Care Access to Care Cancer Cancer Diabetes Diabetes Environmental Health Environmental Health HIV/AIDS HIV/AIDS Immunization and Infectious Diseases Immunization and Infectious Diseases Injury Prevention Injury Prevention Maternal, Infant and Child Health Maternal, Infant and Child Health Mental Health Mental Health Oral Health Oral Health Respiratory Diseases Respiratory Diseases Tobacco Use* Tobacco Use* Substance Abuse* Substance Abuse* Nutrition and Obesity** Nutrition and Obesity** Emergency Preparedness** Emergency Preparedness** *U.S. Healthy Gente objectives **Developmental focus theme

Dissemination of HealthyBorderCalendar December 12, 2003 HealthyBorder Health Cards “Tarjetas de Salud” February 1 – May, 2004 World Tuberculosis (TB) Day March 24, 2004 Border Celebration in Early April World Health Day “Road Safety” April 7, 2004 Binational Conference on Transportation and Road Safety April 14 –16, 2004 South Padre Island, TX 1 st Immunization 1 st Immunization Week of the Americas in the U.S.-MX Border 1 st Wk is April (1 st Dose) 2 nd Wk is July (2 nd Dose) 3 rd Wk is October (3 rd Dose) U.S.-Mexico Border Binational Health Week October , 2004 USMBHC Healthy Border 2010 Program “Find The Kids That We Always Miss”

Immunizations Plans the following objectives: Mexico’s border states will maintain or improve their immunization coverage of 95% in kids under one year of age and ages 1-4; and, Mexico’s border states will maintain or improve their immunization coverage of 95% in kids under one year of age and ages 1-4; and, U.S. border states will reach and maintain an immunization coverage of 90% for kids months old. U.S. border states will reach and maintain an immunization coverage of 90% for kids months old.

United States (2000) Border States:Border Counties: Arizona67.2El Paso67.1 California72.3San Diego72.2 Nuevo Mexico64.5 Texas68.1 (19-35 months old) Immunization Coverage Source: Healthy Border 2010, US National Immunization Survey 2000

Immunization Coverage MEXICO ( June 2003) Border States:Border Counties: Baja California97.2Tijuana96.3 Coahuila98.8Piedras Negras99.1 Chihuahua98.3Ciudad Juárez98.1 Nuevo León97.6Anáhuac 99.6 Sonora98.2Nogales 98.3 Tamaulipas99.7Nuevo Laredo 99.9 (children 1-4 years of age) Source: Healthy Border 2010

Dissemination of Healthy Border Calendar Healthy Border Health Cards World Tuberculosis (TB) Day December 12, 2004 February 1 – May, 2004 March 24, 2004 Border Celebration in Early April HB Calendar Binational TB Case Management Project Focus: Monthly health promotion messages addressing program’s focus themes. Focus: Bilingual health guidelines for promotores, health professionals and community based organizations to promote HB focus themes. Focus: Promotion of the TB case management project materials among health professionals, clinics, hospitals and border region. Partnership between CDC, Mexico Secretariat of Health, Commission and border states. Dissemination: U.S.-Mexico border states, ORO’s, Commission members, Policy Makers, core leading organizations and professionals. A total of 16 guidelines will be developed and distributed by local communities. Evaluation components will be developed. Healthy Border Focus Themes: All the themes plus heart disease, obesity, men’s health, nutrition and tobacco Healthy Border Focus Themes: All the themes plus heart disease, obesity, men’s health, nutrition and tobacco Healthy Border Focus Themes: Infectious Diseases and Access U.S.-Mexico Border Health Commission 2004 Calendar of Core Activities and Initiatives

World Health Day “Road Safety” First Immunization Week of the Americas U.S.-Mexico Border Binational Health Week April 7, st Week is April (1 st Dose) 2 nd Week is July (2 nd Dose) 3 rd Week is October (3 rd Dose) October 18-22, 2004 Binational Conference on Transportation/ Roadway Safety April (South Padre Island, TX) Themes: “An Act of Love”; ”Love Them Protect Them and Immunize Them” First Border Binational Health Week “An Act of Love” 3 rd dose Focus: World Health Day” Road Safety”. Binational conference will focus on road safety. Intended to produce policy recommendations and health promotion messages. Partnership with Commission, Mexico Secretariat of Health, PAHO, CDC, DHHS, UT Pan American Health Office and border states. Focus: Immunization week focuses on children and families; one of a series of three weeks to increase immunization rates among 0-2 year of age. Builds on successes of: Nuestors Niños in New Mexico, Texas and Arizona Partnerships with PAHO, CDC, Commission, Mexico Secretariat of Health and border states. Concept document is no file. California-Mexico Health Initiative Binational Health Week: Binational Healthy Policy Initiative in California and selected Mexico States. First time that the U.S.-Mexico border will participate in the Americas effort. Healthy Border Focus Themes: Unintentional Injuries and Access Healthy Border Focus Themes: Immunizations and Access Healthy Border Focus Themes: Multiple focus themes

Objectives Focus on high risk areas, socio economically poor sectors; Focus on high risk areas, socio economically poor sectors; Reduce health disparities; Reduce health disparities; Increase coverage and access; Increase coverage and access; Implement a one year immunization strategy. Implement a one year immunization strategy. Immunization Week of the Americas in the U.S.-Mexico Border

POPULATION GOAL Children between the ages of 0 and 4 Children between the ages of 0 and 4 GEOGRAPHICAL AREA Sister communities in Mexico and U.S. Border: Sister communities in Mexico and U.S. Border:  Cd. Juárez, Chih. – El Paso, TX - Las Cruces, NM  Tijuana, B.C. – San Diego, CA  Ojinaga, CHIH. – Presidio, TX

Strategies Definition Mobilization of Human Resources Mobilization of Human Resources Strengthening of Alliances Strengthening of Alliances Promotores Promotores Students Students Health Workers Health Workers Educational Workers Educational Workers Public Information Campaign Public Information Campaign

3 Binational Vaccination Weeks April U.S. side – April 30 –May 6 Mexican side. April U.S. side – April 30 –May 6 Mexican side. July (?) July (?) October (to be confirmed) October (to be confirmed)

U.S.-Mexico Border Binational Health Week Goal - To advance implementation of Healthy Border by encouraging and creating sustainable behavioral practices, organizational relationships, and community structures to improve health status and eliminate disparities.

Share easy-to-understand information, health prevention and best practices. Share easy-to-understand information, health prevention and best practices. Strengthen community-based organizational structures and foster partnership opportunities. Strengthen community-based organizational structures and foster partnership opportunities. Leverage financial, technical,organizational support and social capital. Leverage financial, technical,organizational support and social capital. Establish benchmark indicators to evaluate outcomes Establish benchmark indicators to evaluate outcomes Expected Outcomes

Immediate Achievements Partnerships and concrete efforts between Mexico and the U.S. to approach binationally immunization efforts with a border focus. Partnerships and concrete efforts between Mexico and the U.S. to approach binationally immunization efforts with a border focus. Institutionalize the border binational health week. Institutionalize the border binational health week. Establish the border as core partner in the Weeks of the Americas. Establish the border as core partner in the Weeks of the Americas.

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